Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to critically evaluate and summarise all available evidence derived from randomised clinical trials (RCTs) regarding aromatherapy's effects on labour pain and anxiety relief. Literature search was performed in MEDLINE/PubMed, Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus since their respective inception to January 2019. Additionally, Google Scholar was also searched to explore citations of eligible final studies which were subsequently included in the systematic review. The search strategy used was: (pregnancy or pregnant or prenatal or antenatal or perinatal or maternal) AND (aromatherapy or essential oils or aroma therapy). Per inclusion and exclusion criteria established by the current study, nine RCTs were included in the systematic review. Results from the current study suggested that aromatherapy significantly decreased pain and anxiety in the first stage of labour.IMPACT STATEMENTWhat is already known on this subject? Several studies have shown aromatherapy's effectiveness in relieving pain and anxiety for hospitalised patients and on relieving nausea and vomiting for women during pregnancy. Some results have further indicated that aromatherapy was effective in facilitating episiotomy healing and in reducing pain, fatigue and distress. Aromatherapy was also found to play a role in improving maternal moods; reducing post-caesarean pain; and preventing or mitigating stress, anxiety and depression after childbirth. Though most non-pharmaceutical pain management options were considered non-invasive and presumably safe for mothers and their foetuses, their exact efficacies remained unclear due to a lack of high quality evidence.What the results of this study add? This systematic review and meta-analysis summarises all evidence derived from RCTs wherein aromatherapy was performed as a supportive analgesic method during labour. Results of this meta-analysis identified more credible evidence validating that aromatherapy could significantly decrease labour pain both in early active and late active phases.What the implications are of these findings for clinical practice and/or further research? Availability of credible evidence supporting aromatherapy's effectiveness on reducing physiological and psychological stress during pregnancy and childbirth would be useful, both theoretically and practically, for all stakeholders concerned, such as pregnant women, medicine and midwifery students, midwives, nurses, gynaecologists and health policymakers.

Association of oral health-related quality of life and Alzheimer disease: A systematic review.

STATEMENT OF PROBLEM: Oral health-related quality of life (OHRQoL) is a subjective measure that assesses a person's perception of oral health. Patients with Alzheimer disease (AD) suffer from impaired cognitive function and a compromised ability to perform activities of daily living. Further exploration is needed to clarify whether OHRQoL is negatively impacted by cognitive degeneration and oral health conditions among patients with AD. PURPOSE: The purpose of this systematic review was to increase understanding of OHRQoL among patients with AD and explore factors that may affect OHRQoL. MATERIAL AND METHODS: Searches were conducted in PubMed, the Cochrane Library database, Medline, EBSCO, ProQuest, and EMBASE until August 30, 2018, with no date restrictions. The initial search targeted quantitative observational studies published in English that included the keywords AD, oral, prosthesis, and OHRQoL. Data extraction was independently conducted by 2 reviewers. OHRQoL was investigated as the outcome. Cognitive status and oral health conditions were treated as exposures. Tools used to measure OHRQoL included the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile. The research adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Six studies were included. The sample sizes ranged from 30 to 226 participants, 5 studies used cross-sectional designs, and 1 was a nonrandomized controlled trial. Three studies reported higher OHRQoL scores among participants with AD than those among controls, but only 1 study showed a statistically significant difference. A statistical analysis was conducted with 4 studies that reported GOHAI scores, and no significant differences were found in GOHAI scores between participants with AD and controls (standard mean difference: 0.09; 95% confidence interval: -0.66 to 0.85). All studies that explored factors affecting OHRQoL showed different associations between cognitive impairment, oral health conditions, and OHRQoL. One study showed that cognitive impairment was negatively associated with OHRQoL. Three studies found oral health conditions (including periodontitis, gingival bleeding, probing depth >4 mm, and number of natural teeth) impaired the OHRQoL of participants with AD. Three studies reported that prosthetic type and quality positively affected OHRQoL among participants with AD. CONCLUSIONS: OHRQoL may not fully represent actual oral health problems of patients with AD. Clinical dentists should evaluate oral problems in this population, preferably by using both subjective and objective examinations, including oral and dental conditions. This will ensure oral problems among patients with AD can be detected early and timely treatment provided.

Value of ST-segment change in lead aVR in diagnosing left main disease in Non-ST-elevation acute coronary syndrome-A meta-analysis.

BACKGROUND: Previous researches proved that the ST-segment elevation (STE) in lead aVR had great significance on the prediction of severe left main lesion or serious multivessel lesions. The current research is to summarize the published data and evaluate the overall association of STE in lead aVR and left main coronary artery disease (LMD) in Non-ST-elevation acute coronary syndrome. METHODS: Literature searching was performed in the online database, and a systematic review was conducted based on the searched results. Meaningful STE in lead aVR was summarized and analyzed for odds ratio (OR) and 95% confidence intervals (95% CI). RESULTS: Twenty-seven articles were included for final data analysis. Compared with STE < 0.05, STE ≥ 0.05 mV was associated with a higher incidence rate of LMD (OR = 6.64, 95% CI: 4.80 ~ 9.17), and the degree of STE in lead aVR was significantly associated with LMD. Myocardial infarction was more likely to occur in patients with STE ≥ 0.05 mV than in patients with STE < 0.05 mV (OR = 3.12, 95% CI: 1.73 ~ 5.62). CONCLUSIONS: The STE in lead aVR and the degree of STE are independent predictors in diagnosing LMD or myocardial infarction.

Evaluate five different diagnostic tests for dry mouth assessment in geriatric residents in long-term institutions in Taiwan.

BACKGROUND: Residents in long-term care (LTC) institutions require care plans to effectively resolve dry mouth. Simple and easily comprehensible dry mouth indices must be developed to assist care professionals in determining dry mouth among residents. Therefore, this study aim of the study was to evaluate five different diagnostic tests for dry mouth assessment. METHODS: A total of 568 residents were recruited from several LTC institutions in central Taiwan. The research instruments and tools comprised of the characteristics of the residents, state of oral health care, self-perceived ability to chew food, Taiwanese short-form of the Oral Health Impact Profile (OHIP-7 T), self-perceived levels of dry mouth, oral moisture checking, and a repetitive saliva swallowing test (RSST). The data collected were analyzed through demographic analysis, Correlation coefficient and chi-squared automatic interaction detection. RESULTS: Results of the decision tree analysis indicated that RSST results, tooth brushing frequency, and age were the three indices that exerted the greatest influence on oral moisture levels. Specifically, in residents with relatively high RSST results, a daily tooth brushing frequency > 1, and an age < 68 years exhibited more favorable oral moisture levels. The results indicated that residents' self-perceived oral status was not associated with their oral moisture levels. CONCLUSION: The three indices can be provided to LTC institutions for on-site assessment of dry mouth among residents to facilitate early detection of those with dry mouth.

Predictability of successful trans-arterial embolization in pelvic fracture bleeding based on patient initial presentation.

BACKGROUND: Pelvic fracture bleeding generally leads to hemorrhagic shock. Trans-arterial embolization (TAE) is regarded as the most useful treatment; however, the initial presentation of the patient can impact the effectiveness of TAE for pelvic fracture bleeding. The aim of this retrospective study is to explore whether the patient data at the initial presentation can predict the success of TAE for pelvic fracture bleeding. METHODS: Twenty-seven charts were retrospectively reviewed. TAE failure was defined as any patient who eventually received an exigent laparotomy or who died due to uncontrolled bleeding after TAE. For patients who received TAE, we analyzed factors recorded at the initial presentation, including age, gender, systolic blood pressure, heart rate, respiratory rate, body temperature, Glasgow coma scale (GCS) score, injury severity score (ISS) and associated injuries, using Pearson's correlation and independent t-tests. The odds ratio was used to determine the cut-off values for the patient presentation findings related to successful TAE and thus was used to assess congruity. RESULTS: Successful TAE was not correlated with age or gender. The hierarchical order of statistically significant associations between successful TAE and initial presentation data was as follows: the patient's body temperature, associated injury, respiratory rate, systolic blood pressure, GCS score, and ISS. The odds ratios for all statistically significant initial presentation factors were within a 95% confidence interval. CONCLUSION: The findings upon initial presentation of a patient with pelvic fracture bleeding that were related to the predictability of successful TAE include the following: hypothermia prevention with maintenance of the body temperature above 36°C, associated injuries limited to two organ systems, maintenance of the respiratory rate at approximately twenty-two breaths per minute, a sustained systolic blood pressure of approximately 90mmHg, maintenance of a heart rate of approximately one hundred beats per minute, a minor head injury with a GCS score greater than thirteen and a moderate ISS of less than twenty.

Suppression of Cell Growth, Migration and Drug Resistance by Ethanolic Extract of Antrodia cinnamomea in Human Lung Cancer A549 Cells and C57BL/6J Allograft Tumor Model.

The purpose of this study was to investigate the inhibitory activities of ethanolic extracts from Antrodia cinnamomea (EEAC) on lung cancer. Cell proliferation and cell cycle distribution were analyzed using (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) (MTT) assay and flow cytometry, respectively. Wound-healing assay, Western blotting, and a murine tumor model were separately used to examine cell migration, protein expression, and tumor repression. Our results showed that EEAC induced cell cycle arrest at the G0/G1 phase resulting decreased cell viability in A549 cells. Moreover, EEAC up-regulated the growth-suppressing proteins, adenosine 5'-monophosphate-activated protein kinase (AMPK), p21 and p27, but down-regulated the growth-promoting proteins, protein kinase B (Akt), mammalian tarfet of rapamycin (mTOR), extracellular signal-regulating kinase 1/2 (ERK1/2), retinoblastoma protein (Rb), cyclin E, and cyclin D1. EEAC also inhibited A549 cell migration and reduced expression of gelatinases. In addition, our data showed that tumor growth was suppressed after treatment with EEAC in a murine allograft tumor model. Some bioactive compounds from EEAC, such as cordycepin and zhankuic acid A, were demonstrated to reduce the protein expressions of matrix metalloproteinase (MMP)-9 and cyclin D1 in A549 cells. Furthermore, EEAC enhanced chemosensitivity of A549 to paclitaxel by reducing the protein levels of caveolin-1. Our data suggests that EEAC has the potential to be an adjuvant medicine for the treatment of lung cancer.

Demethoxycurcumin-Loaded Chitosan Nanoparticle Downregulates DNA Repair Pathway to Improve Cisplatin-Induced Apoptosis in Non-Small Cell Lung Cancer.

Demethoxycurcumin (DMC), through a self-assembled amphiphilic carbomethyl-hexanoyl chitosan (CHC) nanomatrix has been successfully developed and used as a therapeutic approach to inhibit cisplatin-induced drug resistance by suppressing excision repair cross-complementary 1 (ERCC1) in non-small cell lung carcinoma cells (NSCLC). Previously, DMC significantly inhibited on-target cisplatin resistance protein, ERCC1, via PI3K-Akt-snail pathways in NSCLC. However, low water solubility and bioavailability of DMC causes systemic elimination and prevents its clinical application. To increase its bioavailability and targeting capacity toward cancer cells, a DMC-polyvinylpyrrolidone core phase was prepared, followed by encapsulating in a CHC shell to form a DMC-loaded core-shell hydrogel nanoparticles (DMC-CHC NPs). We aimed to understand whether DMC-CHC NPs efficiently potentiate cisplatin-induced apoptosis through downregulation of ERCC1 in NSCLC. DMC-CHC NPs displayed good cellular uptake efficiency. Dissolved in water, DMC-CHC NPs showed comparable cytotoxic potency with free DMC (dissolved in DMSO). A sulforhodamine B (SRB) assay indicated that DMC-CHC NPs significantly increased cisplatin-induced cytotoxicity by highly efficient intracellular delivery of the encapsulated DMC. A combination of DMC-CHC NPs and cisplatin significantly inhibited on-target cisplatin resistance protein, ERCC1, via the PI3K-Akt pathway. Also, this combination treatment markedly increased the post-target cisplatin resistance pathway including bax, and cytochrome c expressions. Thymidine phosphorylase (TP), a main role of the pyrimidine salvage pathway, was also highly inhibited by the combination treatment. The results suggested that enhancement of the cytotoxicity to cisplatin via administration of DMC-CHC NPs was mediated by down-regulation of the expression of TP, and ERCC1, regulated via the PI3K-Akt pathway.

Relationship between emergency care utilization, ambient temperature, and the pollution standard index in Taiwan.

This study applied a vector error correction model to investigate the effects of ambient temperature (AT) and air quality index values on emergency care utilization (ECU). The Pollution Standards Index (PSI) and total suspended particulates (TSP) were used for analysis. Data were obtained from the National Health Insurance Research Database of the Ministry of Transportation and Communications and Ministry Environmental of Protection Administration of Taiwan. Data from January of 1998 to December of 2012 (180 months) were analyzed. Study results showed that, regardless of long-term equilibrium or short-term dynamics, a 1 °C increase in AT will decrease ECU, showing that AT strongly affects ECU. There were no significant corrections of long-term equilibrium of PSI and TSP on ECU. Only short-term TSP dynamics caused negative effects in the first ECU phase. Emergency care requires special monitoring of AT and TSP to respond to the increased number of high-risk patients consulting emergency departments.

Factors affecting institutionalized older peoples' self-perceived dry mouth.

PURPOSE: The purpose of this study was to determine the factors affecting institutionalized older peoples' self-perceived dry mouth. METHODS: This cross-sectional study was conducted on elderly residents at 22 long-term care facilities. A total of 165 questionnaires were returned from 13 senior citizen welfare institutions (SCWIs) and nine nursing homes. Multiple logistic regression analysis was used to analyze the data obtained. RESULTS: The results showed that the type of long-term care (LTC) facility, regular oral examinations, wearing dentures, and the ability to chew sticky foods affected self-perceived dry mouth. This study determined an association between the type of LTC facility where the participants lived and self-perceived dry mouth. CONCLUSIONS: The results indicated the importance of providing oral care in order to improve and prevent dry mouth among institutionalized older people living in SCWIs who do not undergo regular oral examinations, wear dentures, and have difficulty chewing sticky foods.

Tragic result of traditional Chinese medicine manipulation: an unusual case report of bilateral anterior shoulder dislocations.

BACKGROUND: In Taiwan, there is a good universal healthcare system to the patients; however, the majority of Taiwanese seek the complementary and alternative medicine when they are injured or ill. The traditional Chinese medicine, which is a branch of complementary alternative medicine, is prevalent in Taiwan. Without proper sequence of maneuvers, either traditional Chinese medicine or conventional medicine might cause unexpected complications. We report a case of 76-year-old woman who was manipulated by a bonesetter, leading to bilateral anterior shoulder dislocations. To the authors' best knowledge, this injury mechanism of bilateral shoulder dislocations has not been reported in the literature. Since the traditional Chinese medicine is popular in Taiwan, proper training with better skills for the practitioners should be emphasized. We highlight the integration and collaboration of traditional Chinese medicine with western medicine to achieve a better health care for the patients. CASE PRESENTATION: A 76-year-old Taiwanese woman has been suffering from soreness and stiffness of bilateral shoulders for 6 months. She went to a bonesetter for mobilization for her shoulders. After manipulations for bilateral shoulders, the woman experienced locked both shoulders with sharp pain. She came to our institute, where the radiographs confirmed bilateral anterior shoulder dislocations. Closed reduction for the dislocations was done by the physician. The patient returned to good range of motion of bilateral shoulders after subsequent rehabilitation without any neurologic deficits. CONCLUSIONS: To the authors' best knowledge, this unusual injury of bilateral anterior shoulder dislocations had not been reported. The possible mechanism of this injury and the health belief of traditional Chinese medicine in Taiwan are discussed. Improper shoulder manipulations would lead to unexpected complication in any medical practices. We suggest that both traditional Chinese medicine and conventional medicine should follow specific sequences of manipulations; Collaboration and integration with each other could achieve a better healthcare for the patients.

Impact of removable dentures on oral health-related quality of life among elderly adults in Taiwan.

BACKGROUND: Although the use of removable dentures can improve oral function and esthetics for elderly people, compared to those who do not wear removable dentures, those wearing removable dentures could have worse oral health related-quality of life (OHRQoL). Additional information is required to assess which factors related to denture wearing influence the OHRQoL of elderly individuals. The purpose of this study is to evaluate the association between denture wearing and OHRQoL in a sample of elderly individuals in Taiwan. METHODS: The study population included 277 elderly people wearing removable dentures (mean age = 76.0 years). Using face-to-face interviews, we collected data on the participants' socio-demographic characteristics, dental care service usage (regular dental checkups, treatment during toothache, dental visits in the last year), and factors related to denture wearing (perceived oral pain, perceived loose denture, perceived oral ulcer, perceived halitosis, perceived dry mouth, and perceived total denture satisfaction scores). OHRQoL was measured using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The location and number of remaining natural teeth and the type of denture were also recorded. Hierarchical multiple regression analysis was performed using GOHAI-T scores as the dependent variable. RESULTS: All the predictors together accounted for 50% of the variance in GOHAI-T scores. Further, education level, number of natural teeth, denture status, perceived loose denture, perceived oral ulcer, and perceived total denture satisfaction scores had statistically significant influences on OHRQoL. When compared with other variables, factors related to denture wearing, especially perceived total denture satisfaction scores, had the greatest impact on GOHAI-T scores. CONCLUSIONS: Of the factors analyzed in this study, denture satisfaction was the strongest predictor of OHRQoL. This suggests that denture satisfaction is useful for assessing the effect of denture treatment on the OHRQoL of elderly individuals wearing removable dentures.

Masticatory factors as predictors of oral health-related quality of life among elderly people in Kaohsiung City, Taiwan.

OBJECTIVE: This study aimed to evaluate which masticatory factor is the best predictor of oral health-related quality of life (OHRQoL) in elderly Taiwanese individuals aged 65 years and older. METHODS: Subjects were 332 community-dwelling, independently living elderly adults (mean age, 76.0 ± 0.4 years) in Kaohsiung City, Taiwan. Information concerning age, gender, and socioeconomic status was collected via face-to-face interview questionnaires; the number of food groups rated 'easy to chew' was determined by using food intake questionnaires; and OHRQoL data were obtained by using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The number of natural teeth, functional tooth units, and posterior occlusal contacts according to Eichner Index was assessed by dental examination. Multiple regression analysis was conducted to determine the best masticatory factor that could serve as a predictor of GOHAI scores. RESULTS: The number of food groups rated 'easy to chew' was found to be the only masticatory factor affecting GOHAI-T scores, after adjustment for age, gender, socioeconomic status, and other masticatory variables. As compared to subjects who listed less food groups as 'easy to chew,' subjects who rated more food groups as 'easy to chew' were less likely to have low GOHAI-T scores. CONCLUSIONS: Of the masticatory predictors analyzed in this study, perceived masticatory ability, as measured using a food intake questionnaire, could be the best masticatory predictor of OHRQoL in the elderly.

Decision-making factors affecting different family members regarding the placement of relatives in long-term care facilities.

BACKGROUND: The aim of this research was to investigate factors affecting different family members' decisions regarding the placement of relatives in long-term car (LTC) facilities in Taiwan. The objective was to investigate the correlations between family members' personal traits, the living conditions of residents in the LTC facilities, and family members' experiences with LTC facilities. METHODS: This study selected family members visiting residents in LTC facilities as research subjects and used a structured questionnaire to perform face-to-face interviews. This study used nonlinear canonical correlation analysis (OVERALS) to categorize the decision-making factors affecting family members' choices of LTC facilities. RESULTS: The results showed that when making decisions about the placement of family members, spouses chose facilities according to their own life experiences, children considered medical treatment convenience, grandchildren preferred to collect relevant information on facilities, and other relatives preferred to decide based on introductions from government departments. CONCLUSIONS: These results help clarify how different family roles affect decision-making processes regarding the choice of LTC facilities. In particular, spouses and female relatives require an interventional service mechanism that provides consultation or referral information.

Impact of oral health behaviours and oral habits on the number of remaining teeth in older Taiwanese dentate adults.

PURPOSE: To evaluate the impact of oral health behaviours and oral habits on the number of remaining teeth in older Taiwanese dentate adults. SUBJECTS AND METHODS: Subjects comprised dentate patients (mean age, 60.0 ± 9.9 years) in Taiwan. Information on demographic data, oral health behaviours, oral habits and self-perceived health status was collected via self-administered questionnaires and dentition status was assessed by oral examination. Multiple logistic regression analyses were used to determine variables correlated with the low dentition group (subjects with less than 20 natural teeth or 8 functional tooth units). RESULTS: The analysis showed that the low dentition group was more likely to be older and to exhibit low educational levels, less frequent use of dental floss, more common smoking habits, poor self-perceived dental health and to be exbetel- nut chewers. In addition, the low dentition group was less likely to be current betel-nut chewers. CONCLUSIONS: These results underscore the importance of the use of dental floss and confirm the adverse effects of smoking on dental health. Hence, the dental profession should continue to encourage proper oral health behaviours and oral habits.

Global trend in articles related to stereotactic published in science citation index-expanded.

BACKGROUND: This is the first article using bibliometrics to study the field of stereotactic related research. This study aims to evaluate the global scientific production of simulation research in the category of "stereotactic" during 1993-2008 and to provide insights on the characteristics of the stereotactic related research patterns, tendencies, and methods that might exist in the papers, as well as in leading countries and institutes. METHODS: In this study, "stereotactic*" was used as the keyword to search titles, abstracts, and keywords in the database of the Science Citation Index Expanded. All the articles referring to stereotactic during the studied years, were assessed by the following aspects: document type of publication, characteristics of publication outputs, distribution of outputs in journals, publication outputs of source country, source institute, and analysis of words cluster in title, author keywords, and KeyWords Plus. RESULTS: Eleven document types were found in the total 10 015 publications during 1993-2008. Clinical neurology was the most common category in stereotactic-related research. Neurosurgery listed in categories of clinical neurology and surgery, ranked first. The most productive country and institute were USA and University of Pittsburgh respectively. Words cluster analysis was elaborated regarding the issues of movement disorders, radiosurgery, tumor, and vascular/stroke, it revealed the sharp rise of articles from 1995 until the end of the period covered in "movement disorders" category. CONCLUSIONS: The results analyzed by this bibliometric method can show the research performance, significant events and major inventors, those attributed to stereotactic neurosurgery, and trend of stereotactic related research.

Evaluation of a self-assessed screening test for masticatory ability of Taiwanese older adults.

OBJECTIVES: The aim of this study was to evaluate a screening test based on a food intake questionnaire to discriminate the masticatory ability of Taiwanese older adults with 20 and more natural teeth and at least 8 functional tooth units (FTUs) from the masticatory ability of those with fewer than 20 natural teeth and 8 FTUs. MATERIALS AND METHODS: The subjects were 2244 patients (mean age, 60.4±10.0 years) recruited from 23 counties and cities in Taiwan. Information about their demographic data, dentition, and masticatory ability was collected. Masticatory ability was measured for 23 food groups comprising 35 common Taiwanese foods, and receiver operation characteristic curve analysis was performed. RESULTS: The results showed that the final questionnaire included 14 food groups and a subject choosing 'difficult to eat' responses for 4 and more of these food groups had the same masticatory ability as individuals with fewer than 20 natural teeth and 8 FTUs. CONCLUSION: In conclusion, foods that are the most difficult to eat are not necessarily good discriminatory indicators. Hence, the 14-food group questionnaire can be considered the best screening test for masticatory ability of Taiwanese older adults in terms of the presence of 20 and more natural teeth and at least 8 FTUs.

Factors affecting caregivers' perceptions of residents' oral health in long-term care facilities in Taiwan.

The purpose of this study was to investigate the differences between resident oral care policies provided by 2 types of long-term care (LTC) institutions. The study also investigated factors affecting LTC institutional caregivers' perceptions of the residents' oral health. Overall, 103 completed questionnaires were returned. Of these, 44 were from senior citizen welfare institutions, and 59 were from nursing homes. The variables affecting these perceptions included institution type and whether the residents attended hospital dental clinics or consulted a hospital doctor regarding oral health problems. The research results showed that institution type and whether an oral care-related professional was available in an institution were correlated with an increase in institutional caregivers' perceptions of oral care.

Simultaneous bilateral floating knee: A case report.

BACKGROUND: The phrase "floating knee is a flail knee joint," referring to ipsilateral femoral and tibial fractures, was first used by Blake and McBryde in 1975. This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues, and is accompanied by life-threatening systemic complications, including head, chest or abdominal injuries and a high incidence of fat embolism. Floating knee is a severe and uncommon injury pattern. CASE SUMMARY: A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van. His injuries included traumatic hypovolemic shock, comminuted and open type II fractures of the left femoral shaft, fracture of the right femoral shaft, comminuted fracture of the bilateral tibial and fibular shaft, and multiple lacerations and abrasions on his forehead, lower lip, neck and limbs. The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries. After emergency treatment and the exclusion of life-threating complications, open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts. CONCLUSION: Simultaneous bilateral floating knee is a rare and severe injury pattern. The treatment is challenging, and complications. We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident. We also offer our treatment experience of this complex injury and review past literature.

Effectiveness of intergenerational participation on residents with dementia: A systematic review and meta-analysis.

AIM: This meta-analysis evaluated the effectiveness of intergenerational program participation for long-term care institution residents with dementia. DESIGN: A systematic review and meta-analysis. METHODS: Ten electronic databases were systematically searched until August 2020: CINAHL, the Cochrane Library, EBSCO, EMBASE, Ovid Medline, ProQuest, Psychology and Behavioral Sciences Collection, PubMed, Scopus, and Web of Science. The Joanna Briggs Institute tool (JBI tool) was used for the quality appraisal of the included publications, and Review Manager 5.3 was used for the meta-analysis. RESULTS: Thirteen articles were identified (1993-2015). Intergenerational program participation could improve the pleasure level and significantly reduce disengagement behaviours of residents with dementia. The intergenerational program intervention caused no apparent improvement in their quality of life, depression levels, and engagement levels.

Anti-Oxidative Effect of Pu-erh Tea in Animals Trails: A Systematic Review and Meta-Analysis.

This study adopted systematic literature review and meta-analysis methodology to explored anti-oxidative effect of pu-erh tea. Study authors have systemically searched seven databases up until 21 February 2020. In performing the literature search on the above-mentioned databases, the authors used keywords of pu-erh AND (superoxide dismutase OR glutathione peroxidase OR malondialdehyde). Results derived from meta-analyses showed statistically significant effects of pu-erh tea on reducing serum MDA levels (SMD, −4.19; 95% CI, −5.22 to −3.15; p < 0.001; I2 = 93.67%); increasing serum SOD levels (SMD, 2.41; 95% CI, 1.61 to 3.20; p < 0.001; I2 = 91.36%); and increasing serum GSH-Px levels (SMD, 4.23; 95% CI, 3.10 to 5.36; p < 0.001; I2 = 93.69%). Results from systematic review and meta-analyses validated that various ingredients found in pu-erh tea extracts had anti-oxidation effects, a long-held conventional wisdom with limited supporting evidence.